The occurrence of autoantibodies to an islet-cell protein of 64,000 Mr (64KA) was examined in relation to development of insulin-dependent diabetes. 64KA were absent in 26 normal controls and present in only 1 of 41 first-degree relatives who lacked islet-cell cytoplasmic autoantibodies (ICA) or insulin autoantibodies (IAA). Among first-degree relatives at high risk for IDD, 64KA were identified in 23 of 28 persons positive for ICA and 4 of 5 with IAA but no ICA. Among 31 patients with newly diagnosed IDD, 64KA were found in 26. 64KA were identified in 23 of 28 persons studied up to 75 months before clinical onset of IDD. Of these 23 64KA-positive prediabetic subjects, 5 were ICA-negative and 10 lacked IAA. 64KA were most predictive in those who became diabetic before age 34 (22/24). In several individuals, 64KA were detected before the other autoantibodies appeared. These findings suggest that 64KA may be an early and useful predictive marker for IDD.